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Wavefront sensing and control are important for enabling one of the key advantages of using large apertures, namely higher angular resolution. Pyramid wavefront sensors are becoming commonplace in new instrument designs owing to their superior sensitivity. However, one remaining roadblock to their widespread use is the fabrication of the pyramidal optic. This complex optic is challenging to fabricate due to the pyramid tip, where four planes need to intersect at a single point. Thus far, only a handful of these have been produced due to the low yields and long lead times. To address this, we present an alternative implementation of the pyramid wavefront sensor which relies instead on two roof prisms. Such prisms are easy and inexpensive to source. We demonstrate the successful operation of the roof prism pyramid wavefront sensor on an 8 m class telescope, at visible and near-infrared wavelengths, for the first time using a SAPHIRA HgCdTe detector without modulation for a laboratory demonstration, and elucidate how this sensor can be used more widely on wavefront control test benches and instruments. [ABSTRACT FROM AUTHOR]

Subclinical thyroid disorders are commonly encountered in the primary care setting. This article aims to review the latest evidence and guidelines pertaining to the management of subclinical hypo- and hyperthyroidism, in particular the important decision of when treatment should be considered.

Infrared avalanche photodiode (APD) arrays represent a panacea for many branches of astronomy by enabling extremely low-noise, high-speed, and even photon-counting measurements at near-infrared wavelengths. We recently demonstrated the use of an early engineering-grade infrared APD array that achieves a correlated double sampling read noise of 0.73 e− in the lab, and a total noise of 2.52 e− on sky, and supports simultaneous high-speed imaging and tip-tilt wavefront sensing with the Robo-AO visible-light laser adaptive optics (AO) system at the Palomar Observatory 1.5 m telescope. Here we report on the improved image quality simultaneously achieved at visible and infrared wavelengths by using the array as part of an image stabilization control loop with AO-sharpened guide stars. We also discuss a newly enabled survey of nearby late M-dwarf multiplicity, as well as future uses of this technology in other AO and high-contrast imaging applications. [ABSTRACT FROM AUTHOR]

Objective: Rush University Medical Center nursing leadership undertook a process improvement project to revamp nursing handoff during unit transfer with the goal of improving patient throughput. The aim was to decrease assign-to-occupy time, the duration from bed assignment to bed occupancy., Background: There was a lengthy lag time in admitting/transferring patients, leading to delays in patient throughput and potential threats to patient safety. In fiscal year 2016, assign-to-occupy time averaged 97 minutes. The goal was to decrease that time to 60 minutes or less., Methods: Process improvement leaders held a rapid improvement event to determine viable solutions. A team then standardized handoff workflow; created an electronic tool, virtually eliminating verbal report; and implemented a new handoff process., Results: Assign-to-occupy time at 1 year after go-live averaged 55 minutes, and it has been staying less than 60 minutes since the implementation., Conclusions: Key success strategies included engaging stakeholders during the rapid improvement event, imploring frontline nurses to create and promote the revised process to facilitate staff engagement, and leveraging electronic health records.

Background: Little is known about optimization of electronic health records (EHR) systems in the hospital setting while adoption of EHR systems continues in the United States., Objective: To understand optimization processes of EHR systems undertaken in leading healthcare organizations in the United States., Methods: Informed by grounded theory approach, a qualitative study was undertaken that involved 11 in-depth interviews and a focus group with the EHR experts from the high performing healthcare organizations across the United States., Results: The study describes EHR optimization processes characterized by prioritizing exponentially increasing requests with predominant focus on improving efficiency of EHR, building optimization teams or advisory groups, and standardization. The study discusses 16 types of optimization that interdependently produced 16 results along with identifying 11 barriers and 20 facilitators to optimization., Conclusion: The study describes overall experiences of optimizing electronic health records in select high performing healthcare organizations in the US. The findings highlight the importance of optimizing the EHR after, and even before, go-live and dedicating resources exclusively for optimization.